Rate Transparency

Verify Payment Adherence and Compare Rates to Peers.

The Transparency in Coverage rule (2022) requires insurers to publicly disclose their negotiated rates—but these files are massive, unstandardized, and nearly impossible to navigate without specialized infrastructure. We built that infrastructure.

How We Use Transparency Data

At MedResolutions, transparency-in-coverage data helps us prepare evidence-based IDR submissions. Certified IDR entities consider the parties' offers, the QPA, and credible information tied to the factors permitted by the No Surprises Act. We use transparency files to identify negotiated-rate context for comparable providers, regions, and procedure codes. That context can support a submission, but the certified IDR entity decides each dispute on its own record.

Process source: CMS, About the Independent Dispute Resolution Process.

But our use of this data extends well beyond IDR. We've built the capability to:

• Search Contracted Rates: Quickly look up what specific payers are paying for any CPT code, in any market—giving you instant visibility into the rate landscape.
• Generate Market Benchmarks: Build custom reimbursement benchmarks by specialty, geography, and procedure type using real negotiated-rate data across hundreds of payers.
• Compare Rates to Peers: See how your reimbursement compares to similarly situated providers in your region, and identify where you may be systematically underpaid.
• Verify Payment Adherence: Cross-reference insurer payments against their own disclosed contracted rates to confirm you're being paid what you're owed under your agreement.
• Generate Custom Data Pulls: We can produce bespoke data reports tailored to your practice's specific payers, procedures, and geographies—on demand.

Rate transparency is no longer just a regulatory checkbox—it's a strategic asset. MedResolutions turns one of the most complex datasets in healthcare into clear, actionable intelligence for your practice.